The UN Principles of Older Persons in European Elderly Care Environments

1. Toward Active Old Age –conference 24.4.2004 Pori,Finland Dr. Kari A Sirkka & Prof. Merja Nikkonen: The UN Principles of Older Persons in European Elderly Care Environments -A Community Analysis on Elderly Care Environments in Four European Countries Sirkka K.A. & Nikkonen M (2004)

2. Toward Active Old Age –conference 24.4.2004 Pori,Finland Research questions: • How do the UN Principles of Older Persons (46/91) appear in the elderly care practice from perspectives of physical, psychosocial and symbolic care environments in the target institutions selected in the four European countries? • What are the similarities and diversities regarding the basic elements constructing physical, psychosocial and symbolic elderly care environments in the target institutions selected in the four European countries? • What kind of overview and future challenges does the sample provide of the elderly care culture in the target institutions selected in the four European countries? Sirkka K.A. & Nikkonen M (2004)

3. Methodology: • Toward Active Old Age –project members chose the target institutions in each of the four countries involved in this study. The institutions were supposed to be “the average level” elderly care institutions in the country in order to provide a more general perspective to elderly care environments in each country. • The staff and residents in each target institution were informed in advance about the contents, the means used and the purpose of this study. All the information published in this report is based on free personal consents to be used as informants (by observation, interviews, photographing) in this study. A copy of this report will be delivered to each institution involved. • The data collection process was independent from the institutions (translator not working for/ in the institution) objectivity Sirkka K.A. & Nikkonen M (2004)

4. Methodology: • The data collection and analysis followed the four-phased Genesis- community analysis model(Artinian & Conger 1997, 180-182; STAKES 2003) : • organising the audit visits in each target institution. The institutions involved sent the authors package of information consisting the generic information (with some statistics), care philosophy and areas of care activities of the institution • 2) two-day audit visits in each institution (audit programs included general tours in the institutions, meetings with the administration, staff, residents, relatives, civil servants dealing with elderly care, as well as spontaneous talks with people in their daily activities) ; the observational data was collected simultaneously during the rounds and interviews. Each audit day ended by checking and comparing the data both authors had collected. Also the management of each institution organised a short meeting for briefing the spontaneous impressions and notices done during the audit days. • focused on deeper thematic analysis by means of a qualitative constant comparison method that involves the systematic sifting and comparison of items of interview- and observation memos to reveal and establish an internal structure of categories (Green 1998) • drawing the conclusions and publishing the findings according to the order of the UN principles Sirkka K.A. & Nikkonen M (2004)

5. UNITED NATION'S PRINCIPLES FOR OLDER PERSONS (46/1991) IN THE CARE OF THE ELDERLY independence participation care self-fulfilment dignity • Organisational interaction and communication climate: Values General atmosphere Treating the clients staff behaviour well-being of the staff in their work SOCIETAL PRIORITIES • The INSTITUTION AS AN ELDERLY CARE ENVIRONMENT • Physical environment • Psychosocial environment • Symbolic environment PHYSICAL PSYCHOSOCIAL CULTURAL ELEMENTS IN THE INSTITUTION • Organisational value basis in care: care philosophy: • objectives for the care: • staff qualifications and other requirements Study design: Sirkka K.A. & Nikkonen M (2004)

6. Reflections on the findings Care philosophy: • Audited organisations represent a variety from medicine-oriented institutions to centres of diversified residential and non-residential care services • the most common issues namedas valuebasis despite of the type of organisation were: • home-likeness • respect of a person • holistic care • self-reliance • rehabilitation Organisational value basis in care • The concepts are not so clear among staff members, and the terms require organisational level definitions and agreements on what they mean in OUR SERVICES Sirkka K.A. & Nikkonen M (2004)

7. Reflections on the findings Staff qualifications and other requirements: • The amount of qualified staff varies between 40 – 94 %  The more qualified staff the more medicalised the care • Despite of the organisation’s philosophy or ideological frame, the staff members are hired to do certain tasks or fill certain posts • tend to maintain power structure on staff- or task-orientation in services (rather than client- or life phase orientation) • Investments on the well-being of the staff were not done too much (except some annual parties – no systematic training programs, prizing or other motivation systems) Organisational value basis in care Sirkka K.A. & Nikkonen M (2004)

8. Reflections on the findings INDEPENDENCE 1. physical environment =… factors facilitating self-reliance, autonomous living, and safe activities in physical environment #”AQUARIUM SYNDROME” TOO EXTRAVAGANT OR TOO POOR FACILITIES SEEM TO HAVE SAME AFFECT TO DEPRESS INDEPENDENCE BUILDINGS AS ARCHITECTURAL MONUMENTS LABEL AND SEPARATE RESIDENTS FROM OUTER SOCIETY AS MUCH AS POOR FACILITIES # SAFETY RISKS RISKS IN PERSONAL SAFETY REQUIRE PERSONAL ALARM SYSTEMS (not only apartmental ones) Sirkka K.A. & Nikkonen M (2004)

9. Reflections on the findings INDEPENDENCE 2. psychosocial environment =… a question of personal freedom, self-determination in decision-making and dignity • #KEEPING TOUCH TO SOCIETY • ALL INCLUSIVE INTRA-MURALSERVICES DIMINISH NEED OF GOING OUT OF THE BUILDING • MIGHT SUPPORT INDEPENDENCE IN THE HOUSE BUT REDUCES ABILITY TO MANAGE IN EXTRA-MURAL SOCIETY • # ECONOMIC INDEPENDENCE •  POVERTY IS AN EVERY DAY REALITY AMONG THE ELDERLY Sirkka K.A. & Nikkonen M (2004)

10. Reflections on the findings INDEPENDENCE 3. symbolic environment =… balancing oneself with taking the risk of being a burden to the staff when asking help or giving up and loosing the autonomy • #PERSONAL IDENTITY AND FREEDOM • INDEPENDENCE IS A QUESTION OF PRESERVING ONE’S PERSONAL FREEDOM, IDENTITY, BEING A SUBJECT OR A PERSON # PERSONAL FACILITATING •  SAFETY IS TO RECEIVE TRUSTWORTHY SUPPORT IN DECISION-MAKING PROCESSES AND HAVING SOMEONE AS RESIDENT'S ADVOCATE (TRUST) Sirkka K.A. & Nikkonen M (2004)

11. Reflections on the findings PARTICIPATION 1. physical environment =…physical factors facilitating involvement and attendance in various activities • #”ENTERTAINMENT SYNDROME” • ACTIVITIES FOCUSED MOSTLY ON ENTERTAINING RATHER THAN DEVELOPING THE RESIDENT'S FULL MENTAL AND KOGNITIVE POTENTIAL  PARTICIPATION IS NOT QUESTION OFROOM IN THE FIRST PLACE (transport, attitude, encouragement, meaningful activities) Sirkka K.A. & Nikkonen M (2004)

12. Reflections on the findings PARTICIPATION 2. psychosocial environment = … as issues related to being a subject (or object) and possibilites to attend to societal activities as an ordinary citizen # PARTICIPATION REQUIRES MOTIVATION  CREATING MEANINGFUL AND BENEFICIAL ACTIVITIES TO PARTICIPATE IN (passive participation does not necessarily produce well-being)  BREAK DOWN OF MENTAL BARRIERS HINDERING THE INVOLVEMENT IN THE DAILY LIFE IN THE HOUSE (standing at the door side of the kindergarten rather than daring to get involved etc.) Sirkka K.A. & Nikkonen M (2004)

13. Reflections on the findings PARTICIPATION 3. symbolic environment = …commitments in allowing personal freedom and investment both in human resources and the technical aids #UTILISING ELEMENTS OF MEANINGFUL LIFE AND HUMAN RESOURCES PERSONAL SKILLS, KNOWLEDGE AND LIFE EXPERIENCE IN BETTER USE # ”MINIMUM LEVEL LIFE”  ACCEPTING EXTERNAL REGULATION, BEING HAPPY TO LIVE ”EASY LIFE” IN ENVIRONMENT WITH BASIC SERVICES Sirkka K.A. & Nikkonen M (2004)

14. Reflections on the findings CARE 1. physical environment = … hygienic facilities, variety of technical aids, dining facilities, and human resources invested on care • #DO GOOD FACILITIES QUARANTEE GOOD CARE? •  CARE STILL OFTEN SEEN AS WORK CONFINED TO CERTAIN SPACE RATHER THAN TRANSFERRABLE OR MODIFIABLE (professional or non-professional) ACTIVITY • LIVING IN THE HOTEL >< HOLISTIC CARE Sirkka K.A. & Nikkonen M (2004)

15. Reflections on the findings CARE 2. psychosocial environment = …attempts to deal with physical, mental and social needs in the frames of societal resources #WELL-BEING AND LONELINESS  CULTURALLY LABELLED CONCEPTS  PROFESSIONALS TOO HASTILY DIAGNOSING AND FINDING ”SCIENTIFIC” EXPLANATIONS INSTEAD OF LISTENING THE MESSAGE  WHAT CREATES THE SENSE OF BEING CARED FOR?  Sirkka K.A. & Nikkonen M (2004)

16. Reflections on the findings CARE 3. symbolic environment = …. 1) activities supported or implemented by persons authorised to the task, 2) standard package of services based on diagnosis or care plan, 3) as various packages of services provided according to mutual agreement with the customer • #LIFE-ORIENTATION, PERSON-ORIENTATION OR SERVICE ORIENTATION? • VARIETY OF CARE ACTIVITIES AVAILABLE ("SOMETHING FOR EVERY ONE") INSTEAD OF UTILISING ”NORMAL” SITUATIONS TO CARE PURPOSES (like reminiscing, health education, ”history projects”, exhibitions etc) • TAILORED SERVICES MAY LEAD TO: -risk of purhasing services more than finance can afford -unequality among the residents Sirkka K.A. & Nikkonen M (2004)

17. Reflections on the findings SELF-FULFILMENT 1. physical environment = … physical factors maintaining one’s personal identity and the image of one’s real possibilities to go on with one’s own life • #PRIVACY • PERSONAL SPACE WITH POSSIBILITIES TO KEEP PERSONAL BELONGINGS VARY FROM 60 CM SHELF (IN 3 M2 SPACE) TO 55 M2 PRIVATE APARTMENT HOW TO INTEGRATE PRIVACY AND COMMUNALITY Sirkka K.A. & Nikkonen M (2004)

18. Reflections on the findings SELF-FULFILMENT 2. psychosocial environment = … possibilities to utilise the knowledge and skills of the elderly. Being active understood as physical activity • # INVESTMENT ON HUMAN DEVELOPMENT • VERY LITTLE INVESTED ON EDUCATION OR HUMAN DEVELOPMENT • THE RESIDENTS’ PROFESSIONAL KNOWLEDGE, SKILLS OR LIFE EXPERIENCES NOT UTILISED IN FULL POTENTIAL (i.e. in collaboration with schools, day care units, adult education centres…)  VISION OF DOING THINGS THAT WERE NOT POSSIBLE BEFORE RETIREMENT SEEM TO BE GIVEN UP Sirkka K.A. & Nikkonen M (2004)

19. Reflections on the findings SELF-FULFILMENT 3. symbolic environment = …beliefs in being aged differ between helpless children, exploited financial resource for the rest of the family to respected persons as long as one is able to take care of one’s own business • # DREAMING ABOUT SAFE AND WORRILESS LIFE •  AGEING IS NEVER A PROBLEM AS LONG AS ONE IS ABLE TO CARE FOR ONESELF • TASK ORIENTED ELDERLY CARE IS NOT APPEALING BUT HOW ABOUT PERSON- OR WELL-BEING ORIENTED CARE?  SIFFICULTY TO KNOW WHAT YOU ARE ALLOWED TO WANT AFTER LONG HISTORY OF HAVING NO OPTIONS Sirkka K.A. & Nikkonen M (2004)

20. Reflections on the findings DIGNITY 1. physical environment = … principles of both physical and mental safety and respect of one’s privacy #PHYSICAL > < MENTAL SAFETY  WHERE DOES THE DANGER STAND (INSIDE OR OUTSIDE) ? Sirkka K.A. & Nikkonen M (2004)

21. Reflections on the findings DIGNITY 2. psychosocial environment = …respecting one as a person, kind behaviour, equality in approaching the residents, and making various activities as nice and comfortable as possible to the residents • # SOCIAL > < ETHICAL SAFETY •  BOARDING HOUSES (with all inclusive full board) MAY TURN TO ”BEING BORED” -HOUSES • GOOSE MARCH PHENOMENON  SERVICES OFFERED SHOULD NOT TURN TO FINANCIAL EXPLOITATION Sirkka K.A. & Nikkonen M (2004)

22. Reflections on the findings DIGNITY 3. symbolic environment = …opportunities to maintain one’s personal life style and taste • #PERSONAL SAFETY • FREEDOM TO BE WHO YOU ARE • “”Nothing would change even if the Queen moved in here” •  EQUALITY BETWEEN RESIDENTS AND THE STAFF Sirkka K.A. & Nikkonen M (2004)

23. HOME: -cosy and comfortab-family roles -mental landscape RESID-ENTIAL SER-VICE CENT-RES -providing services to assist in daily activities -housing and various activities -entertainment WHERE DOES THE FUTURE STAND? ASYL-UM Typology of elderly care institutions Sirkka K.A. & Nikkonen M (2004)

24. Future challenges: • Institutional level: • -flexibility and integration of fragmented services for everybody’s benefit • -development of new approach to services • (life histories; education for third age; resource-thinking etc.) • -facilitating and empowering staff and residents together to innovations • (creating possibilities for residents to develop their self-fulfilment in full potential) • -changing philosophy frommedicalisation or uniformed charity to serving clients based on their individual needs • (well-being rather than treatment) • -actions to encourage family involvement in clients’ lives Sirkka K.A. & Nikkonen M (2004)

25. Future challenges: • Residential/ client level: • -claim of bigger role and involvement in one’s own care & life in institutions • -shortage of meaningful activities • -utilisation of residents’ knowledge and skills better in voluntary work (meaningful things to do) • -lack of privacy • -how to maintain the same level in dignity when a person got ill or demented? • -connections with family members • (phone connections, facilities to spend time together) • -financial situation due to poor social security should not affect the residents’ status as citizens and human beings Sirkka K.A. & Nikkonen M (2004)

26. Future challenges: • Staff level: • -getting rid of traditional burden of doing on one’s behalf to keep ”wheels running” • -avoiding the culture of separation among/ between the staff and the residents • -changes in working culture from task task-centred thinking to client- or service-oriented approach • -focus more on well-being • -from job/ position -orientation to facilitating • -focus set on the sense of becoming cared • -obtain and apply new knowledge on elderly care (gerontological, resource oriented approach to care) • -clarifiying organisational/ personal values on regular basis (esp. how to apply into practice) Sirkka K.A. & Nikkonen M (2004)

27. People have to move there when they no longer remember their home address… …but they still are capable of controlling 12 BINGO tickets simultaneously. Do You know what is peculiar in old age homes? No. What then? Sirkka K.A. & Nikkonen M (2004)

28. THANK YOU FOR YOUR ATTENTION www.activeoldage.com Satakunnan ammattikorkeakoulun raportit 1/2004 Sirkka K.A. & Nikkonen M (2004)